Lots of teens think that arthritis is something only their grandparents get, but it's actually a condition that affects people of all ages. Read on to find out about juvenile rheumatoid arthritis, a specific kind of arthritis that usually occurs in people under age 17.
What Is Juvenile Rheumatoid Arthritis?
The term rheumatoid (pronounced: roo-mah-toid) refers to diseases that affect the muscles, tendons, joints, bones, or nerves.
Arthritis is an inflammation (which means that it's characterized by heat, swelling, and pain) of the synovial (pronounced: suh-no-vee-ul) membrane (the lining of the joints, such as the knees or knuckles). When the synovium becomes inflamed, fluid is produced, and the joints can become stiff, swollen, painful, and warm to the touch. Over time, inflammation in a joint can cause damage to cartilage and bone.
About 285,000 kids and teens in the United States have some form of arthritis. Juvenile rheumatoid arthritis (JRA) is the most common kind of arthritis among kids and teens. Usually diagnosed between the ages of 2 and 16, it's also called juvenile idiopathic arthritis (JIA) because it is different from adult rheumatoid arthritis.
Symptoms of JRA can come and go many times over the course of the condition. Although JRA mostly affects the joints and surrounding tissues, it can also affect other organs, like the eyes, liver, heart, and lungs. JRA sometimes causes only minor symptoms and problems, but in some cases it can cause serious joint damage or limit growth.
Kids and teens with JRA may have pain and stiffness that can change from day to day or from morning to afternoon. Flares are periods of time when the condition becomes more active and symptoms worsen.
JRA is a chronic condition, meaning it usually lasts for a relatively long period of time (at least 6 weeks or more) and can last for months and years. Sometimes the signs and symptoms just go away on their own, which is called remission. Remission may last for months, years, or for a person's lifetime. In fact, many teens with JRA eventually enter full remission with little or no permanent joint damage.
Types of JRA
The three major types of JRA are:
- Oligoarticular (pronounced: awl-li-go-ar-tik-yoo-lur) JRA. The prefix oligo means "few" and articular means "associated with a joint or joints." This kind of JRA involves four or fewer joints and usually affects larger joints such as the knee. About half the kids and teens with JRA have the oligoarticular type. It generally begins in young children between infancy and age 5. Sometimes iridocyclitis (pronounced: ire-ih-doe-si-kleye-tis), an inflammation in front of the eye near the iris (the colored part of the eye) also occurs. For this reason, eye exams are important, even when the arthritis is not active.
- Polyarticular (pronounced: pa-lee-are-tick-yoo-lur) JRA. The prefix poly means "many." Polyarticular JRA affects five or more joints, usually the small ones in the hand and fingers. It also can affect the knees, hips, ankles, feet, and neck. Polyarticular JRA may have symmetric involvement of joints, meaning it affects the same joint on each side of the body. Involved joints are usually swollen. Symptoms may include a low-grade fever, tiredness, poor appetite, and rheumatoid nodules (bumps) on the affected joints. This form of JRA can lead to long-term joint problems and frequently requires treatment with strong medications.
- Systemic (pronounced: sis-teh-mick) JRA. Systemic JRA can affect several parts of the body, including internal organs and joints. This is the least common form of JRA. The first signs of systemic JRA are usually high fevers, chills, and a rash. Arthritis may begin with the fevers or not until weeks or months later. Fever usually occurs late in the afternoon or evening and can go up to 103º Fahrenheit (39.4º Celsius) or higher and return to normal within a few hours. The person may feel very sick when his or her temperature is high but fine during the rest of the day. About half of the kids and teens with systemic JRA recover completely, whereas the other half experience joint symptoms, such as pain and stiffness, which may persist for many years. In some cases the effects of the disease, such as decreased movement, stiffness, and pain in the joints, may last into adulthood.
What Causes JRA?
Although scientists don't know the exact causes of JRA yet, much research is being done on JRA and other forms of arthritis. They do know that JRA involves abnormalities of the immune system, which defends our bodies against germs, such as bacteria and viruses.
When the immune system isn't working properly — as in a condition like JRA, for example — it has difficulty telling the difference between germs and the body's own tissues. This confusion causes the immune system to mount an attack and release chemicals that actually damage the body's own healthy tissues. This results in the type of inflammation that causes the symptoms of JRA.
It is also known that JRA is not contagious. You can't catch it from someone else or pass it along to another person the way you might a cold or other infection.
What Do Doctors Do?
JRA can be difficult to diagnose. All forms of this type of arthritis involve inflammation, but they also cause a variety of symptoms and require different kinds of treatment. No single test can diagnose all the forms of JRA and other types of arthritis. The doctor will do a complete physical examination to detect joint swelling, eye problems, and rashes. He or she may do blood tests, X-rays, and, in some cases, may use a needle to take a sample of synovial (joint) fluid for examination.
The doctor may need to follow the course and symptoms of a person with JRA for several months to determine the particular type the person has. The doctor will also take your medical history by asking you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues.
Certain infections, such as parvovirus infection and Lyme disease, have similar symptoms and may be mistaken for JRA. These possibilities must be ruled out before a diagnosis of JRA can be confirmed.
How Is JRA Treated?
When JRA is diagnosed early and treated appropriately, it can usually be managed effectively and damage to joints can be limited or prevented. Medical care is aimed at easing the symptoms of JRA and may include medications to reduce inflammation (like ibuprofen). Newer medications, such as methotrexate and etanercept, can keep the immune system in check and control the disease far better than was possible 10 or 15 years ago.
Range-of-motion physical therapy (exercises that improve flexibility), and the use of heat can also help control symptoms. Surgery is very rarely needed to repair damaged joints.
Living With JRA
If you have JRA, some mornings it may be hard to get out of bed. Maybe you reach for your sock on the floor, and you can't straighten your elbow or bend your knees. Or you touch your shoulder, and it feels tender, warm, and painful. Periods of inactivity, like sleeping for 8 hours, can be followed by stiffness.
It may be tempting to roll back into bed and sleep the day away. But this can make things worse. Even though you may feel lousy sometimes, you can help yourself feel better. Just as runners, bodybuilders, and other athletes do stretching exercises to warm up, you can use gentle massaging and stretching to help soothe the muscles and ligaments around your sore joints. Once you're up and moving, the discomfort usually lessens. Exercise can help keep full motion in your joints and strengthen your muscles and bones. A physical therapist can help you plan an effective exercise program to do at home.
Proper nutrition can improve your overall health, and a registered dietitian can help you to understand the basics of a healthy diet. For example, you might feel sick and unable to eat as much when you experience a flare. A dietitian can assist you in selecting foods that have a higher nutritional value to compensate for a poor appetite.
A positive mental outlook is just as important as exercise and a healthy diet. If you feel depressed or angry sometimes, talk to someone who can support you. Tell your parents, your doctor, or a friend about how you feel. Some teens with JRA become more comfortable with the condition by asking questions and learning as much as possible. It may also help to do simple things that we often take for granted. For example, each day try to schedule something to do that you enjoy and that makes you happy.
Most teens with JRA do the same stuff as other teens — they go to regular schools, help around the house, hang out with their friends, and are active physically, academically, and socially. Remember, your doctor and other medical professionals are there to support you and can help you manage the condition so that it has the least possible impact on your life.
Reviewed by: AnneMarie C. Brescia, MD
Date reviewed: June 2008